Healthcare Provider Details

I. General information

NPI: 1497901110
Provider Name (Legal Business Name): JAHANDAR SAIFOLLAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SADDLE BACK CENTER, BUILDING 751-E KENMORE AVENUE, S.E.
GRAND RAPIDS MI
49546-2391
US

IV. Provider business mailing address

PO BOX 1596
BATTLE CREEK MI
49016-1596
US

V. Phone/Fax

Practice location:
  • Phone: 616-977-1770
  • Fax: 616-977-1775
Mailing address:
  • Phone: 269-969-6108
  • Fax: 269-969-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301079449
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: